Individual
MRS. BETH STACY FREEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD CDN
Contact information
Practice address
455 W 256TH ST, BRONX, NY 10471-2413
(917) 796-2502
Mailing address
455 W 256TH ST, BRONX, NY 10471-2413
(917) 796-2502
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
005987-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11898975
CAQH
NY
Enumeration date
01/09/2009
Last updated
01/09/2009
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